No contract yet between CFVH, Humana

Medicare recipients in Sanders County who formerly had Blue Cross Blue Shield coverage have until Feb. 28 to choose a new plan, and as of now Clark Fork Valley Hospital (CFVH) has been unable to sign a contract with a new provider.

CFVH continues to negotiate with Humana, and CFVH Chief Financial Officer Carla Neiman said they will have a decision by the end of January to ensure seniors have time to make their decision on coverage.

“We do not have an indication at this point whether we will be successful in reaching an agreement that will allow us to participate with Humana during 2018,” Neiman said.

Blue Cross Blue Shield of Montana announced in October that it would no longer provide Medicare coverage in many areas of Montana, including Sanders County. CFVH then began pursuing a contract with Humana after an insurance broker began offering Humana Medicare Advantage plans to Sanders County residents, even though Clark Fork Valley Hospital currently is not an in-network provider for Humana.

“If you have enrolled in the Humana HMO Plan (Humana Gold Choice HMO) effective January 1, 2018, you should be aware that if you seek services at Clark Fork Valley Hospital or one of our clinics, you are currently out of network and, as a result, you have no Medicare coverage for non-emergent services,” Neiman said. “Again, the only exception is emergency services, as defined by Humana.”

Neiman in October said that if seniors choose the Humana plan and CFVH does not have a provider contract with Humana, people could face consequences such as higher copays for services.

Humana is not the only option for seniors. Neiman said that seniors can enroll in traditional Medicare, which includes a Part B premium, copays and deductibles. Medicare supplements are also an option for seniors. Supplements cover the coinsurance and deductibles that Medicare does not pay. Neiman noted that the Humana supplement plans “are 100% fine.”

If seniors cannot afford a Medicare supplement plan, the CFVH Financial Assistance Program is another option. The program covers up to 100% of the balance after Medicare, depending on income. Other state programs are also available, and the Agency on Aging can provide more information about those programs.

“We know that you have a choice of health care providers, and we value our relationship with you,” Neiman said. “As we have seen, insurance providers will come and go, but Clark Fork Valley Hospital is committed to caring for the residents of Sanders County and we will always be here to serve our community. We sincerely regret this situation which has developed beyond our control and we will continue to do our best to address it.”

CFVH and the Area VI Agency on Aging will present meetings at area senior centers starting this week to answer questions and provide more information to Medicare recipients. Meetings are scheduled in Hot Springs, Thompson Falls, Noxon, Plains and Heron.